Shouldn’t any pharmacy be able to assist in an anaphylaxis emergency?

On the Wednesday evening before Christmas, 14-year-old Emma Sloan tragically died from anaphylaxis on O’Connell Street in Dublin. She had been for a meal with her family at a Chinese buffet and had eaten satay sauce (which contains peanuts) by mistake. She had a known nut allergy but did not have her adrenaline auto-injector with her that evening. When she began to suffer an allergic reaction, her mother went into a nearby chemist to ask for an EpiPen. The pharmacy said they were unable to give out an adrenaline auto-injector without a prescription and advised the family to go to A&E. Emma died a few metres outside the chemist. RTÉ has reported that the Pharmaceutical Society of Ireland has launched an investigation.

Any report of an anaphylaxis death is incredibly sad to read. In this case, there is the added question mark of whether the pharmacy could and should have supplied the emergency adrenaline.

Could a similar tragedy occur in the UK?

It seems so. According to the EpiPen website, in the UK, EpiPens are “only available on prescription from your doctor”. From what I’ve read (and I hasten to add I have no medical/pharmacy background), although adrenaline is a “POM” (prescription only medicine) an exemption exists allowing it to be “administered” in an anaphylaxis emergency. However, I am not clear if this means a UK pharmacist could “dispense” adrenaline in an anaphylaxis emergency.

The “orange cross” scheme in Scotland

In Scotland, whilst adrenaline auto-injectors are only available on prescription, Community Pharmacy Scotland (CPS) launched a campaign last summer in respect of anaphylaxis emergencies. The scheme has been backed by Lib Dem MP Jo Swinson, who suffered anaphylaxis and required an adrenaline injection in May 2013.

Under the scheme, wherever a Scottish pharmacy displays an orange anaphylaxis treatment cross, that pharmacy can provide “trained help in an anaphylaxis emergency”.

I contacted CPS for further details and they have confirmed this means that participating pharmacies will each stock at least one adrenaline injection 300mcg per dose (adult) and at least one adrenaline injection 150mcg per dose (child). The producers of both Epipen and Jext have also provided the pharmacies with training and support materials. 

CPS told me:

“Anaphylaxis is an issue with which community pharmacists are well placed to advise patients (even around correct use and expiry etc of pens), so we feel it was important to raise awareness for the pharmacies as well as the public. So far around 890 of our pharmacies have opted in and should be showing the orange cross within their pharmacy premises.”

Until we get to the stage where adrenaline auto-injectors are held in public places (nurseries, schools, restaurants, shopping centres, railway stations etc) in the same way as some venues hold defibrillators, schemes such as the CPS orange cross scheme are a very welcome and reassuring step in the right direction.

Please England, Wales and Northern Ireland: can you follow suit?

Update: UK pharmacists’ powers in life saving emergency

Please see extremely interesting comment from a pharmacist on the Nutmums facebook page (thank you, Kristeen).

Sources and further information

(image courtesy of Community Pharmacy Scotland)


One comment

  1. This is very intersting reading. I am an aesthetic nurse. I cannot get a vial adrenaline or epipen anywhere. No one can give me either without a prescription. No one will write me a prescription for emergency because it has to be a named person. I cannot buy one anywhere. I am trying to get a friend I have in Asia who is going to organise this for me without a prescription then I have a dilemma. Is it the correct thing. Is it legal to do this. My dilemma is though. If I inject a filler to someone and they go into anaphylaxis and die. I would be wishing I had chanced the Asian adrenaline rather than nothing. Sorry if I was chemist in Irrland I would have given epipen and worried about probls fore later. I do not want a guilt like that. But what do I do?? I have asked Scottish inspectorate for help this morning.

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